Provider Demographics
NPI:1417115809
Name:ABELARDO G CONTRERAS MD PC
Entity Type:Organization
Organization Name:ABELARDO G CONTRERAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABELARDO
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-689-7100
Mailing Address - Street 1:P.O. BOX 252375
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-2375
Mailing Address - Country:US
Mailing Address - Phone:586-558-5666
Mailing Address - Fax:586-558-9333
Practice Address - Street 1:29135 RYAN ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4279
Practice Address - Country:US
Practice Address - Phone:586-558-5666
Practice Address - Fax:586-558-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAC0385842084N0400X
43010385842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1430383Medicaid
MIA73972Medicare UPIN
MI1430383Medicaid